Postpartum depression may occur not only in the mother but also in spouses, which affects their quality of life, increases the social and family economic burden, and is not conducive to the growth and development of the child. Therefore, it is important to identify the factors that influence its occurrence at an early stage.
To clarify the incidence of postpartum depression in Chinese maternal spouses through meta-analysis.
A computerized search was performed for cohort studies, case-control studies, and cross-sectional studies on the incidence of postpartum depression in Chinese maternal spouses in the databases of CNKI, Wanfang Data, VIP, CBM, PubMed, Web of Science, CINAHL, Embase, and Cochrane Library, with the time of search being from the establishment of the databases to March 2024. The search was conducted from the time of database construction to 2024-03-19. Two researchers independently screened the literature, and the included studies were subjected to data extraction, literature quality assessment, and meta-analysis by Stata 14.0 software.
39 papers were finally included, with a total sample size of 12 162 cases. Meta-analysis results showed that the prevalence of postpartum depression among maternal spouses in China was 14% (95%CI=12%-17%). The results of subgroup analysis showed that the incidence of postpartum depression in spouses was 17% (95%CI=13%-22%) within 1 month postpartum and 13% (95%CI=10%-15%) within 1 month-1 year postpartum; the incidence was 17% (95%CI=11%-23%) in inland areas and 13% (95%CI=11%-16%) in coastal regions; the measurement tool EPDS showed an incidence of 13% (95%CI=11%-16%) for spouses in studies using the EPDS and 18% (95%CI=10%-29%) for other study instruments; the incidence of postpartum depression was 15% (95%CI=11%-21%) for spouses of primiparous women and 14% (95%CI=11%-18%) for spouses of multiparous mothers. For the year of publication, the incidence was 16% (95%CI=10%-22%) for studies published from 2007 to 2016 and 14% (95%CI=12%-16%) for studies published from 2017 to 2023. Sensitivity analyses were performed by excluding literature one by one, and the combined effect sizes did not change significantly, suggesting that the meta-merged results were relatively robust. The distribution of each study point on both sides of the funnel plot was symmetrical, and the results of Egger's test showed t=1.79, P=0.082, suggesting that there was no significant publication bias.
The incidence of postpartum depression in Chinese maternal spouses is high, with an overall incidence of 14%, of which the incidence is as high as 17% within 1 month postpartum. Early screening and prevention should be emphasized.
Elderly hypertension combined with cognitive impairment has been one of the global public health problems. A systematic evaluation of the prevalence of mild cognitive impairment (MCI) in elderly hypertension patients in China helps provide data support for the prevention and treatment of cognitive impairment in elderly hypertension patients.
To analyze the prevalence rate of MCI in elderly hypertensive patients in China by meta-analysis, and further explore the development trend of the prevalence rate.
Chinese and English databases including CNKI, Wanfang Data, VIP, CBM, PubMed, Cochrane Library, Embase and Web of Science were systematically searched from self-built database to February 22, 2024. NoteExpress software was used for literature management and screening, and the American Institute for Agency for Healthcare Research and Quality (AHRQ) cross-section research evaluation criteria was used for literature quality evaluation. Meta-analysis and subgroup analysis were performed by StataMP 14.0 software.
Twenty-seven cross-sectional studies from 2008 to 2023 were systematically analyzed, involving 57 461 elderly patients with hypertension and 11 812 patients with the disease. A random effects model was used for meta-analysis, and the overall prevalence was 21.3% (95%CI=18.4%-24.2%, P<0.001). A total of 11 provinces/cities/autonomous regions were included in the study, and the prevalence rate varied greatly among provinces/cities/autonomous regions and among geographical regions. The overall prevalence rate showed a fluctuating trend with time from 2008 to 2023. Subgroup analysis showed that the prevalence of MCI was 33.6% (95%CI=6.4%-60.7%, P<0.001) in rural and 21.8% (95%CI=18.1%-25.4%, P<0.001) in urban elderly patients with hypertension. The prevalence in North China (14.0%, 95%CI=9.3%-18.7%, P<0.001) was lower than that in other regions. The prevalence of MMSE+MoCA combined application was 25.9% (95%CI=15.8%-36.0%), and the prevalence of MoCA alone was 21.4% (95%CI=18.5%-24.4%) and MMSE alone was 17.9% (95%CI=13.9%-21.9%) .
The overall prevalence rate of MCI in elderly hypertensive patients in China is high, and there are great differences between different provinces and cities, urban and rural prevalence rate, and the trend of dynamic change with time. The detection rate of MCI varies greatly among different assessment tools, which is affected by the quantity and heterogeneity of literature studies. The conclusion needs to be confirmed by further high-quality studies.
Type 2 diabetes mellitus (T2DM), as a chronic metabolic disorder, represents a significant health threat to middle-aged and elderly populations in China and is a major risk factor for osteosarcopenia. The presence of osteosarcopenia can markedly impact the health status and quality of life of individuals with T2DM. A comprehensive examination of the epidemiological characteristics of osteosarcopenia holds substantial significance in guiding the prevention and management of osteosarcopenia among T2DM patients in China.
To conduct a systematic evaluation of the prevalence of osteosarcopeniain patients with T2DM in China.
A comprehensive search was conducted for studies on the prevalence of osteosarcopenia in Chinese patients with T2DM across multiple databases, including CNKI, Wanfang Data, VIP, SinoMed, Cochrane Library, PubMed, Web of Science, EBSCO and Embase. The search period extended from the establishment of these databases to June 2024. Two researchers independently screened the literature, extracting relevant information such as the first author, publication year, survey period, geographical region, osteosarcopenia prevalence, diagnostic criteria, assessment tools and quality evaluation information. The methodological quality of the included studies was assessed using the AHRQ tool. Data were analyzed using Stata 15.0.
A total of 18 cross-sectional studies were included, involving 3 724 T2DM patients, of whom 623 were diagnosed with osteosarcopenia. The meta-analysis revealed that the overall prevalence of osteosarcopenia in Chinese T2DM patients was 21% (95%CI=15%-26%). Subgroup analysis showed that the prevalence after 2020 (25%) was higher than that before 2020 (19%) ; the prevalence in the elderly group (27%) was higher than in the middle-aged group (13%) ; the prevalence using the AWGS diagnostic criteria (23%) was higher than with the AWGS2 criteria (14%) ; the detection rate by BIA (22%) was higher than by DXA (17%) ; males (38%) had a higher prevalence than females (36%) ; the prevalence in patients with a T2DM duration of ≤10years (25%) was higher than in those with a duration > 10 years (20%) ; the prevalence in the western region (27%) was higher than in the central (18%) and eastern regions (16%) (P<0.05). Meta-regression analysis revealed no statistically significant results (P>0.05), and no significant sources of heterogeneity were identified.
Existing evidence suggests a relatively high prevalence of osteosarcopenia among patients with T2DM in China, with significant disparities observed across factors such as survey period, age groups, diagnostic criteria, assessment tools, gender, duration of T2DM, and regional differences. Consequently, it is imperative to enhance early screening and intervention strategies for high-risk populations, in order to effectively prevent and mitigate the progression of the disease.
Acute kidney injury (AKI) is one of the most common complications of acute respiratory distress syndrome (ARDS) and significantly increases the mortality rate of ARDS patients. Currently, the clinical understanding of ARDS complicated with AKI, effective prevention and treatment measures are not enough. Exploring the possible predictors is significant for early evaluation and effective intervention measures to reduce the incidence and mortality of AKI in ARDS.
To systematically evaluate the risk factors of AKI in ARDS.
PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and SinoMed were searched for literatures on risk factors of AKI in ARDS from inception to December 2023. Two researchers independently screened the literatures according to the inclusion and exclusion criteria, extracted data and assessed the quality of included literatures. RevMan 5.3 software was used for Meta-analysis.
A total of 17 studies involving 6 160 patients were included. Meta-analysis demonstrated that: being older (OR=1.02, 95%CI=1.00-1.03, P=0.007), higher Sequential Organ Failure Assessment (SOFA) scores (OR=1.17, 95%CI=1.05-1.30, P=0.004), diabetes (OR=1.40, 95%CI=1.09-1.80, P=0.008), hypertension (OR=1.56, 95%CI=1.26-1.93, P<0.001), atrial fibrillation (OR=1.76, 95%CI=1.09-2.85, P=0.020), chronic kidney disease (OR=10.31, 95%CI=3.30-32.19, P<0.001), higher neutrophil to lymphocyte ratio (NLR) (OR=1.02, 95%CI=1.00-1.05, P=0.030), higher angiopoietin 2 (Ang-2) (OR=1.84, 95%CI=1.73-1.95, P<0.001), aspartate aminotransferase (AST) >40 U/L (OR=2.27, 95%CI=1.56-3.31, P<0.001), lower arterial blood pH (OR=0.83, 95%CI=0.75-0.92, P=0.000 6), lower glomerular filtration rate (GFR) (OR=0.92, 95%CI=0.75-0.99, P=0.020), mechanical ventilation (OR=2.53, 95%CI=1.96-3.26, P<0.001) and extracorporeal membrane oxygenation (ECMO) (OR=1.81, 95%CI=1.43-2.28, P<0.001) were risk factors for AKI in ARDS. However, gender (OR=1.17, 95%CI=0.82-1.67, P=0.390), BMI (OR=1.27, 95%CI=0.77-2.09, P=0.350), obesity (OR=5.88, 95%CI=0.51-68.28, P=0.160), Acute Physiology and Chronic Health Evaluation Ⅱ scores (OR=1.20, 95%CI=0.99-1.46, P=0.060), heart failure (OR=4.49, 95%CI=0.58-34.70, P=0.150), disturbance of consciousness (OR=1.83, 95%CI=0.88-3.84, P=0.110), pleural effusion (OR=1.16, 95%CI=0.81-1.65, P=0.410), oxygenation index (OR=4.30, 95%CI=0.69-26.77, P=0.120), procalcitonin (OR=1.08, 95%CI=0.95-1.23, P=0.230), white blood cell count (OR=1.56, 95%CI=0.51-4.80, P=0.440) and plasma albumin (OR=1.07, 95%CI=0.97-1.17, P=0.170) were not related to AKI in ARDS.
The risk factors of AKI in ARDS involve many aspects, including general factors (being older), overall assessment (high SOFA scores), disease factors (combined with diabetes, hypertension, atrial fibrillation and chronic kidney disease), laboratory indicators (higher NLR, higher Ang-2, AST>40 U/L, lower arterial blood pH and GFR), and treatment (mechanical ventilation, ECMO). Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by more high-quality studies in the future.
Hypertension as a risk factor can significantly increase the morbidity and mortality of cardiovascular and cerebrovascular diseases, and effective control of hypertension is the key to prevent and treat cardiovascular diseases.
Collect literature on the evaluation of the effectiveness of hypertension management models in China. Evaluate the management effects of different models and provide a reference for further optimization of hypertension management models.
Using StataSE-64, a network Meta-analysis of the 18 included hypertension management model papers was performed using blood pressure control rates as an evaluation metric. The models included five models: joint hospital-community management, community management, hospital treatment management, general management, and combined Internet management.
Joint hospital-community management, community management, hospital management, and combined Internet management are all effective for hypertension control. The order is joint hospital-community management ≈ combined Internet management> hospital treatment management>community management>blank control. Among them, the joint hospital-community management model has significant effect on hypertension control; the joint hospital-community management model and combined Internet management has similar effect; and hospital management has better effect than community management.
In order to improve the hypertension management model, the construction of hospital-community-family management model in primary health care institutions should be promoted, and the combination of chronic disease management model and combined Internet model should be guided to strengthen the whole-life, whole-cycle management of chronic disease patients.
As one of the important evaluation indicators of rehabilitation effect in stroke survivors, social participation has gradually attracted attention. Understanding the cognition and experience of social participation in stroke survivors is beneficial in helping stroke survivors recover quickly, return to families and reintegrate into society. However, the results of single qualitative studies may not be generalisable and representative.
To systematically review the qualitative studies on cognition and experience of social participation in stroke survivors by meta-synthesis methods, so as to provide a reference for further improving the rehabilitation effect of stroke survivors.
PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, CINAHL, JBI evidence-based health care database, CNKI, Wanfang Data, VIP and CBM were searched by computers to screen qualitative studies on cognition and experience of social participation in stroke survivors from inception to November 2022. Pooled meta-integration method was used to perform the meta-synthesis of research themes, implications, classifications and so on.
A total of 14 papers were included, involving 183 stroke survivors, and 26 findings were derived from meta-synthesis, which were summarized into 8 new categories, and 3 integrated findings were finally synthesized, including cognition and experience of social participation in stroke survivors, multiple social participation were limited in stroke survivors by multiple factors, multiple support for social participation was essential in stroke survivors.
Stroke survivors have new insights into social participation, and it is necessary to correct and eliminate the self-identification disorder and limiting factors of social participation, and focus on multi-party support of social participation in stroke survivors.
As the leading cause of death in the world, cardiovascular diseases pose a serious threat to human health. Diet has attracted much attention as an important intervention, but the effect of carbohydrates on cardiovascular disease is unknown.
To analyze the evidence of the correlation between carbohydrate intake and cardiovascular disease risk.
Wanfang Data, CNKI, VIP, SinoMed, PubMed, Cochrane Library and Embase were searched by computer for randomized controlled trials on the risk of carbohydrates and cardiovascular disease published from inception to January 2023. Two researchers performed literature screening, data extraction, and quality evaluation separately. RevMan 5.3 was used for data analysis.
A total of 16 randomized trials were included. Carbohydrate could significantly reduce triglyceride level by 0.17 mmol/L (95%CI=-0.24--0.10, P<0.000 01). The level of triglyceride decreased by 0.25 mmol/L (95%CI=-0.33--0.17, P<0.000 01) in carbohydrate diet intervention for less than 6 months, and 0.15 mmol/L (95%CI=-0.29--0.01, P=0.04) in 12-23 months group. Plasma HDL-C level increased by 0.09 mmol/L (95%CI=0.07-0.10, P<0.000 01), and plasma LDL-C level increased by 0.10 mmol/L (95%CI=0.02-0.17, P=0.01) .
The overall effect of low carbohydrate diet on cardiovascular risk factors is more favorable below 6 months and 6-11 months, but it has no significant effect on cardiovascular risk factors after 2 years, and its long-term effect needs further study.
Post-stroke cognitive impairment (PSCI) brings a heavy burden to patients and their families. An early recognition and intervention can help delay the occurrence and development of PSCI. Therefore, the use of accurate neuropsychological assessment tools to screen for PSCI is essential for the management and treatment of PSCI.
To analyze the screening accuracy of assessment tools for PSCI by meta-analysis, thus providing references for an accurate screening of PSCI.
Diagnostic trials on screening tools of PSCI published from the establishment of the database to December 2022 were searched in CNKI, VIP, Wanfang Data, SinoMed, PubMed, Embase, Web of Science, Cochrane Library. Two researchers respectively screened literatures, extracted data, and assessed the risk of bias. Stata 17.0 software was used to analyze the data.
A total of 57 articles were included, involving 7 assessment tools [the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network 5-Minute Battery (NINDS-CSN 5-Minutes), the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Examination (MMSE), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Telephone Interview for Cognitive Status Modified (TICS-m) and the Montreal Cognitive Assessment 5-minute protocol (MoCA-5 min) ] to screen 12 113 patients. Meta-analysis results showed that the combined sensitivity and specificity of MoCA in screening PSCI were 0.84 (95%CI=0.80-0.87) and 0.74 (95%CI=0.67-0.80), respectively, with a combined area under the curve (AUC) of 0.87 (95%CI=0.84-0.90). The combined sensitivity and specificity of MMSE in screening PSCI were 0.73 (95%CI=0.67-0.79) and 0.76 (95%CI=0.69-0.82), respectively, with a combined AUC of 0.81 (95%CI=0.77-0.84). The combined sensitivity and specificity of IQCODE in screening PSCI were 0.73 (95%CI=0.48-0.89) and 0.95 (95%CI=0.75-0.99), respectively, with a combined AUC of 0.91 (95%CI=0.88-0.93). The combined sensitivity and specificity of the NINDS-CSN 5-min in screening PSCI were 0.83 (95%CI=0.78-0.87) and 0.69 (95%CI=0.60-0.76), respectively, with a combined AUC of 0.85 (95%CI=0.81-0.88). The combined sensitivity and specificity of the ACE-R in screening PSCI were 0.90 (95%CI=0.80-0.95) and 0.61 (95%CI=0.19-0.91), respectively, with a combined AUC of 0.90 (95%CI=0.87-0.92). The combined sensitivity and specificity of TICS-m in screening PSCI were 0.84 (95%CI=0.75-0.91) and 0.67 (95%CI=0.61-0.74), respectively, with a combined AUC of 0.66 (95%CI=0.60-0.71) .
The combined AUC of IQCODE and ACE-R is larger, and the former as a higher combined specificity and the latter has a higher combined sensitivity. Therefore, IQCODE and ACE-R are optimal assessment tools to accurately screen PSCI. Due to the limited number of literatures reporting the IQCODE and ACE-R in screening PSCI, our conclusions still need to be validated by multicenter and large-sample studies.
The incidence rate of stroke is high and the risk of recurrence is substantial. Most stroke patients need to transition to home after treatment, and the experience during this period is complex. Therefore, there is an urgent need to comprehensively understand experiences and feelings of patients during hospital to home transition through Meta-integration.
To systematically evaluate qualitative studies on stroke patients' hospital to home transition experiences.
A computerized search was undertaken for qualitative studies on the hospital to home transition experience of stroke patients in the PubMed, Web of Science, Scopus, Embase, CINAHL, PsycINFO, CNKI, and Wanfang Data from inception to July 11, 2023. The quality of the final included literature was evaluated using the Joanna Briggs Institute (JBI) Quality Evaluation Criteria for Qualitative Research (2016), Australia, and the results were combined using a pooled integration approach.
A total of 13 studies were included, and 46 findings were distilled and categorized into 7 categories, yielding three final integrative findings: dynamic changes in the physical and psychosocial dimensions have interactive effects; a strong need for holistic caregiving; and active coping with illness and gradual transition to a new life norm.
During the period of transition from hospital to home, stroke patients face complex physical and mental challenges as well as multi-level care needs. Healthcare providers should pay attention to the real experiences and unmet needs of stroke patients throughout the hospital to home transition, provide holistic and continuous care services, and facilitate the comprehensive physical, psychological and social transition for patients.
The assessment of psychological resilience can facilitate an understanding of how patients utilize internal and external resources to adapt to adversities, traumas, significant life stressors, and disease treatment. At present, the unity of self-reported scales for assessing the psychological resilience of cancer patients remains controversial. Furthermore, it lacks the integration and standardized evaluation of scale measurement properties, and the selection of evaluation tools lacks evidence-based evidence.
To systematically assess the measurement properties of a psychological resilience evaluation tool for cancer patients and critically examine the study's methodological quality, therefore to provide a reference for healthcare professionals in selecting a high-quality assessment tool.
A systematic search of databases like PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, VIP, CBM, and Wanfang Data was conducted for literature related to the evaluation of the measurement properties of the Cancer Psychological Resilience Scale. The search was done within the time frame of the database's creation to 2023-02-14. All identified articles were rated by two independent assessors following the COSMIN guidelines.
Thirteen studies were included, and among the nine cancer psychological resilience tools were the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), the Resilience Scale Specific to Cancer (RS-SC), the 10-item Resilience Scale Specific to Cancer (RS-SC-10), the 14-item Resilience Scale (RS-14), the Brief Resilient Coping Scale (BRCS), the SV-RES Resilience Scale (SV-RES), the Ego-Resiliency Scale (ER89-R12), the Pain Resilience Scale (PRS), and the Shift and Persist Questionnaire. All scales—aside from the RS-SC-10, which suggested a "C" because of its poor cross-cultural validity—were rated "B" because of their ambiguous content validity and differing levels of evidence.
This systematic review provides an overview of psychological resilience assessment tools used in cancer patients. The RS-SC stands out as being one of the most robust instruments for measuring psychological resilience in patients. Evidence needs to be generated and used in the clinical setting.
The global prevalence of low back pain is gradually increasing, and it is the main cause of disability, sick leave, and unemployment, posing a heavy burden on individuals and society. Assessing the degree of disability in patients with chronic low back pain is crucial for evaluating the efficacy of clinical interventions and clinical epidemiology. The Roland-Morris Disability Questionnaire (RMDQ) is currently the main tool for evaluating disability in patients with low back pain, but the applicability of its measurement performance in the Chinese population remains unclear.
To evaluate the applicability of RMDQ in the Chinese population with low back pain and provide evidence for clinical practice and research application.
CNKI, Wanfang Data Knowledge Service Platform, SinoMed, PubMed, Embase and Web of Science were searched from inception to 2023-10-01, to establish a literature base for the performance of the low back pain scale, and then select research on the measurement performance of RMDQ from it. The measurement performance of the RMDQ scale was evaluated according to the COSMIN system evaluation guidelines, and the evidence evaluation level was used to grade the evidence.
A total of six RMDQ documents were included, with insufficient methodological quality for RMDQ content validity and adequate measurement performance. The quality of internal consistency methodology was very good with uncertainty and measurement performance was adequate; the methodological quality of retesting was uncertain, and the measurement performance was sufficient; the methodological quality of measurement error was uncertain, and the measurement performance was sufficient; the methodological quality of criterion validity was uncertain, and the measurement performance was insufficient; hypothesis testing methodological quality was very good with uncertain, and the measurement performance was sufficient and uncertain; the quality of reactivity methodology was very good, with sufficient and insufficient, while the measurement performance was sufficient with insufficient. According to the GRADE evidence quality rating results, there is low quality evidence to prove uncertainty in content validity, and moderate quality evidence to prove sufficient retesting reliability and internal consistency; there is sufficient evidence of low quality to prove the measurement error and reactivity. There is very low quality evidence of insufficient calibration validity when using the Oswestry Dysfunction Index (ODI) and the Visual Analog Scale (VAS) as calibrators; hypothesis testing had moderate quality evidence of uncertainty.
The methodological quality of the RMDQ scale is not high, with acceptable measurement performanceand low quality of evidence, and needs to be used cautiously in clinical practice or trials of low back pain in China. Although there is sufficient evidence of moderate quality to prove the reliability and internal consistency of retesting, the research content and methods are not standardized. In future research, attention should be paid to standardization to more accurately assess its applicability in the Chinese population.
Stroke, as a major chronic non-communicable disease, seriously affects the health of the nation and imposes a heavy burden on patients, families and society. Alcohol consumption is common in China, and there is a close relationship between alcohol intake and stroke incidence, but the relationship between alcohol intake and stroke incidence is still controversial.
To investigate the relationship between alcohol intake and risk of stroke.
PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang Data, and SinoMed were searched for prospective cohort studies on the relationship between alcohol intake and risk of stroke from inception to December 2023. Literature screening, data extraction, and literature quality evaluation were performed independently by 2 researchers. Stata/MP 17.0 was used for dose-response meta-analysis.
A total of 16 papers with 548 595 study subjects were included. Meta-analysis results showed that alcohol intake was associated with the risk of stroke (RR=1.17, 95%CI=1.10-1.26, P<0.05). The results of the subgroup analysis showed that the risk of stroke was increased by 10% for alcohol intake <20 g per day (RR=0.90, 95%CI=0.85-0.95, P<0.05) ; alcohol intake >40 g increased the risk of stroke by 35% (RR=1.35, 95%CI=1.23-1.49, P<0.05) ; alcohol intake increased the risk of hemorrhagic stroke by 49% (RR=1.49, 95%CI=1.14-1.95, P<0.05), alcohol intake ischemic stroke risk increased by 20% (RR=1.20, 95%CI=1.00-1.43, P<0.05) ; alcohol intake in Asian populations increased the risk of stroke incidence by 27% (RR=1.27, 95%CI=1.14-1.40, P<0.05) ; intake alcohol in men increased the risk of stroke by 19% (RR=1.19, 95%CI=1.09-1.29, P<0.05). Dose-response Meta-analysis showed a J-shaped nonlinear relationship between alcohol intake and risk of stroke (P=0.018), and the relative risk ratios of stroke for alcohol intake in drinkers compared with never-drinkers were 1 g/d: RR=0.97, 95%CI=0.96-0.98; 2 g/d: RR=0.96, 95%CI=0.94-0.97; 3 g/d: RR=0.95, 95%CI=0.93-0.97; 4 g/d: RR=0.94, 95%CI=0.91-0.96; 5 g/d: RR=0.91, 95%CI=0.88-0.94; 6 g/d: RR=0.90, 95%CI=0.86-0.93; 7 g/d: RR=0.88, 95%CI=0.84-0.92; 8 g/d: RR=0.88, 95%CI=0.83-0.92; 9 g/d: RR=0.88, 95%CI=0.83-0.92; 10 g/d: RR=0.88, 95%CI=0.83-0.93; 11 g/d: RR=0.88, 95%CI=0.83-0.93; 12 g/d: RR=0.90, 95%CI=0.85-0.95; 13 g/d: RR=0.91, 95%CI=0.85-0.95; 14 g/d: RR=0.92, 95%CI=0.86-0.95; 15 g/d: RR=0.93, 95%CI=0.86-0.96; 16 g/d : RR=0.95, 95%CI=0.88-0.96; 17 g/d: RR=0.96, 95%CI=0.88-0.97; 18 g/d: RR=0.98, 95%CI=0.89-0.97; 19 g/d: RR=0.98, 95%CI=0.89-0.98; 20 g/d: RR=0.99, 95%CI=0.90-0.99, and drinkers with an average alcohol intake of <20 g per day showed a reduced risk of stroke (P<0.001) .
There is a J-shaped nonlinear dose-response relationship between alcohol intake and the stroke risk, with moderate alcohol intake negatively associated with stroke risk. The risk of stroke is lowest with an average alcohol intake of 7-11 grams per day.
Chronic atrophic gastritis is a common clinical precancerous lesion, which is prone to recurrent attacks and seriously affects the quality of life of patients. At present, Western medicine has limited effect in the treatment of chronic atrophic gastritis, while acupuncture has good results in the treatment of chronic atrophic gastritis, but which acupuncture therapy is the best still inconclusive.
To compare the clinical efficacy among different acupuncture and moxibustion therapies on chronic atrophic gastritis by network meta-analysis.
The articals of randomized controlled trials for chronic atrophic gastritis treated with acupuncture and moxibustion therapies were searched from CNKI, Wanfang Data, VIP, CBM, PubMed, Embase and Web of Science until April 30, 2023 according to the inclusion exclusion criteria. Literature quality assessment was based on ROB2 bias assessment tool, network meta-analysis was performed using RStudio software, and funnel plotting was used Stata software for publication bias risk assessment.
26 articles involving 10 interventions with a sample size of 2 068 cases were included. The results of network meta-analysis showed that in clinical efficacy, there were five acupuncture therapies were superior to conventional western medicines, including western medicine combined with acupoint injection, catgut embedment in acupoint therapy, western medicine combined with acupuncture, needle warming therapy and acupuncture (P<0.05). The SUCRA ranking result was western medicine combined with acupoint injection (0.86) >catgut embedment in acupoint therapy (0.80) >western medicine combined with acupuncture (0.67) >needle warming therapy and acupuncture (0.59) >western medicine combined with fire dragon moxibustion (0.58) >acupuncture (0.48) >western medicine combined with ginger separated moxibustion (0.40) >thunder-fire moxibustion (0.31) >western medicine combined with electroacupuncture (0.24) >conventional western medicine (0.06). In improving the efficacy of gastroscopy, five acupuncture therapies were superior to conventional western medicines, including catgut embedment in acupoint therapy, needle warming therapy, western medicine combined with acupuncture, acupuncture and western medicine combined with acupoint injection (P<0.05). The SUCRA ranking results show: catgut embedment in acupoint therapy (0.80) >needle warming therapy and acupuncture (0.72) >western medicine combined with acupuncture (0.58) >acupuncture (0.47) >western medicine combined with acupoint injection (0.41) >conventional western medicine (0.01). In terms of pathological efficacy, there were five acupuncture therapies that were superior to conventional western medicines, such as catgut embedment in acupoint therapy and needle warming therapy and acupuncture (P<0.05). The SUCRA ranking results show: catgut embedment in acupoint therapy (0.79) >western medicine combined with acupuncture (0.59) >needle warming therapy and acupuncture (0.53) >acupuncture (0.52) >western medicine combined with acupoint injection (0.51) >conventional western medicine (0.06) .
Western medicine combined with acupoint injection is preferred for patients with obvious clinical symptoms, while catgut embedment in acupoint therapy is preferred for patients with no obvious symptoms. Catgut embedment in acupoint therapy can not only improve the clinical efficacy, but also improve the efficacy of gastroscopy and pathological than other acupuncture treatments.
Shoulder-hand syndrome is one of the major disabling factors for stroke patients, which seriously affects their physical and psychological health as well as their quality of life. Currently, there are many non-pharmacologic treatments used to treat post-stroke shoulder-hand syndrome, but there is still some confusion about which non-pharmacologic treatment modality is more effective in clinical practice.
To provide evidence-based support for clinical decision-making, this network meta-analysis evaluates the efficacy of seven non-pharmacological treatments in improving outcomes for post-stroke shoulder-hand syndrome, pain as measured by the Visual Analogue Scale (VAS), and scores on the simplified Fugl-Meyer Assessment (FMA) .
A computerized search of databases including CNKI, Wanfang Data, VIP, China Biomedical Literature Service System, PubMed, Embase, and Cochrane Library was conducted for randomized controlled trials on non-pharmacological treatments for post-stroke shoulder-hand syndrome up to June 2023. Two researchers independently screened the literature and extracted data, performing the network meta-analysis using RevMan 5.3 and Stata 15.0.
The analysis included 62 studies involving 5 090 patients, assessing interventions such as acupuncture, herbal fumigation, extracorporeal shockwave therapy, moxibustion, herbal hot compress, electrical stimulation, and herbal soak. Results showed that all seven non-pharmacological treatments were superior to the control group in improving overall effectiveness, and FMA scores (P<0.05). Except for moxibustion, the six non-pharmacological treatments were superior to the control group in improving VAS scores in patients with shoulder hand syndrome (P<0.05). In terms of improving overall effectiveness, the cumulative ranking probability area (SUCRA) scores for the treatments were: acupuncture (86.1%), herbal soak (77.1%), herbal fumigation (54.7%), extracorporeal shockwave (53.1%), hot compress (49.0%), electrical stimulation (48.4%), and moxibustion (31.1%), with conventional control treatment at (0.4%). For VAS score improvement, the SUCRA scores were: hot compress (81.3%), herbal soak (78.4%), acupuncture (76.7%), electrical stimulation (58.4%), herbal fumigation (52.7%), extracorporeal shockwave (32.9%), moxibustion (18.1%), and conventional control (1.5%). For FMA score improvement, the SUCRA scores were: herbal soak (90.6%), acupuncture (83.5%), herbal fumigation (59.9%), electrical stimulation (59.8%), extracorporeal shockwave (42.3%), moxibustion (39.7%), hot compress (24.1%), and conventional control (0.2%) .
Compared to conventional treatments, the use or combination of non-pharmacological treatments yields better therapeutic outcomes for treating post-stroke shoulder-hand syndrome. However, due to limitations in the original studies, these conclusions need to be substantiated by further clinical trials.
Cerebral microbleeds (CMBs) are important diseases that seriously endanger our national health, and their incidence is positively correlated with age. Meanwhile, CMBs are also an independent risk factor for stroke recurrence and induced hemorrhagic stroke. Understanding the current prevalence of CMBs is of great practical significance for promoting healthy aging and strengthening stroke prevention and treatment in China.
To systematically evaluate the current status of the occurrence of CMBs in China and to provide data support for promoting the process of healthy aging and strengthening the prevention and treatment of stroke in China.
Literature related to the occurrence of the disease of CMBs in our national population was systematically searched through Chinese and English databases such as CBM, CNKI, Wanfang Data, VIP, PubMed, Embase, and Web of Science, with a timeframe of the establishment of the database until November 2023 for all searches. Two researchers separately performed literature screening, data extraction, and evaluation of the risk of bias in the included literature, and meta-analysis was performed using Stata 16.0 software.
A total of 39 studies were included, with a total of 25 877 study subjects. Meta-analysis showed that the overall incidence of CMBs in China was 25.0% (95%CI=21.0%-29.0%). The results of subgroup analysis showed that the prevalence was 27.0% (95%CI=12.0%-44.0%) for those aged 51-60 years, 23.0% (95%CI=16.0%-30.0%) for those aged 61-70 years, and 27.0% (95%CI=20.0%-35.0%) for those aged 71-80 years; the prevalence was 21.0% (95%CI=15.0%-28.0%) in North China, 26.0% (95%CI=21.0%-33.0%) in East China, 21.0% (95%CI=8.0%-39.0%) in South China, 21.0% (95%CI=16.0%-27.0%) in Central China, 24.0% (95%CI=21.0%-27.0%) in Southwest China and 46.0% (95%CI=41.0%-51.0%) in Northwest China by geographic area; the prevalence of CMBs with a history of hypertension was 19.0% (95%CI=13.0%-26.0%) and without a history of hypertension was 8.0% (95%CI=6.0%-11.0%) ; the prevalence of CMBs with a history of smoking was 9.0% (95%CI=5.0%-14.0%) and without a history of smoking was 16.0% (95%CI=12.0%-21.0%) .
The overall prevalence of CMBs in China is high, with significant differences between different age segments, regions, and provinces. Its prevalence was higher in people of advanced age, males, Northwest China, and nationals with a history of hypertension. Due to the limitations in both quantity and quality of the included studies, further confirmation of this conclusion through additional high-quality research is required.
Chronic kidney disease has become a major global concern, and the prevalence of kidney disease in China is the highest in the world. About 89.5% of patients require hemodialysis. In recent years, the prevalence of frailty in maintenance hemodialysis (MHD) patients has risen significantly, seriously affecting the quality of life and prognosis of patients.
To explore the prevalence of frailty and the influencing factors of maintenance hemodialysis patients in China through Meta-analysis.
Cross-sectional and cohort studies on the prevalence and influencing factors of frailty in Chinese MHD patients were systematically searched in CNKI, VIP, CBM, Wanfang Data, Web of Science, PubMed, Cochrane Library, Embase, and CINAHL databases. The search deadline was from the respective databases to July 2023. Literature screening, data extraction and quality assessment were performed independently by two researchers. Stata 15.0 was used for meta-analysis.
Thirty-two papers were included, and including 6 746 patients, among which 2 566 experienced frailty, involving 37 influencing factors. Meta-analysis showed that the prevalence of frailty in MHD patients in China was 37.4% (95%CI=30.3%-44.5%). Age (OR=1.09, 95%CI=1.06-1.13), age>60 years (OR=3.81, 95%CI=2.31-6.30), female (OR=2.13, 95%CI=1.47-3.08), living alone (OR=2.42, 95%CI=1.22-4.80), sleep (OR=1.28, 95%CI=1.08-1.50), depression (OR=1.97, 95%CI=1.26-3.08), age on dialysis (OR=3.25, 95%CI=1.82-5.79), social support (low level) (OR=1.99, 95%CI=1.39-2.86), comorbidities (OR=1.79, 95%CI=1.40-2.30), malnutrition (OR=1.17, 95%CI=1.07-1.28), Charlson Comorbidity Index (CCI) (OR=1.32, 95%CI=1.01-1.71), C-reactive protein (CRP) (OR=1.15, 95%CI=1.09-1.21), hemoglobin (Hb<110 g/L) (OR=2.70, 95%CI=1.67-4.36), comorbid diabetes (OR=2.16, 95%CI=1.48-3.16), comorbid cerebrovascular disease (OR=2.66, 95%CI=1.85-3.82), comorbid coronary heart disease (OR=3.50, 95%CI=2.15-5.70) were risk factors for frailty MHD (P<0.05) ; economic income (OR=0.02, 95%CI=0.01-0.14), social support (high level) (OR=0.86, 95%CI=0.76-0.97), well nutrition (OR=0.47, 95%CI=0.26-0.85), ability to perform activities of daily living (ADL) (OR=0.80, 95%CI=0.70-0.91), serum albumin (ALB) (OR=0.84, 95%CI=0.77-0.91), Hb≥110 g/L (OR=0.70, 95%CI=0.54-0.90), 25-hydroxyvitamin D[25- (OH) VD] (OR=0.69, 95%CI=0.49-0.98) were protective factors for MHD frailty (P<0.05) .
The prevalence of frailty in MHD patients in China is at a high level, in which age, female, living alone, economic income, sleep, depression, age on dialysis, social support, comorbidities, nutritional risk scores, ADL, CCI, CRP, ALB, Hb, 25- (OH) VD, comorbid diabetes mellitus, comorbid cerebrovascular disease, and comorbid coronary heart disease are mainly factors influencing of MHD frailty patients in China, and in the future, there is a need for early screening and intervention to slow down or avoid the occurrence of hemodialysis frailty in patients.
Cardiovascular disease (CVD) is the leading cause of death in China and the world as a whole, and lipid metabolism disorder is the key factor for this disease. A comprehensive understanding of the prevalence of dyslipidemia in children and adolescents can contribute to the early prevention of dyslipidemia in adulthood.
To systematically evaluate the status quo of the prevalence of dyslipidemia in Chinese children and adolescents.
Cross-sectional studies on the morbidity rate of dyslipidemia among Chinese children and adolescents and published from January 2015 to July 2023 were retrieved from databases of CBM, CNKI, Wanfang, VIP, Embase, Web of Science and Cochrane Library. Processes of literature screening, data extraction and risk bias analysis were performed by two researchers. A meta-analysis was performed by taking advantage of Stata 17.0.
34 cross-sectional studies were collected and a total of 134 438 children and adolescents were involved. Results of the meta-analysis indicated that the overall morbidity rate of dyslipidemia in Chinese children and adolescents was 19% (95%CI=16%-21%), and the morbidity rates of high cholesterol (TC), high triacylglycerol (TG), high low-density lipoprotein cholesterol (LDL-C), low high-density lipoprotein cholesterol (HDL-C) were 6% (95%CI=5%-7%), 9% (95%CI=6%-12%), 4% (95%CI=3%-5%) and 10% (95%CI=7%-13%) respectively. Regarding time distribution, the detection rate of dyslipidemia was fluctuant and showed a decreasing trend; the detection rate of high TC and high LDL-C showed an increasing trend in general, but it fell slightly in 2023; the detection rate of high TG and low HDL-C fluctuated greatly: the detection rate of high TG gradually decreased from 2018 to 2022 and rebounded slightly in 2023. The results of subgroup analysis showed that, concerning age, the overall morbidity rate of dyslipidemia in children and adolescents and that of high TC showed an ascending tendency with the increasing of age (10% and 2% for those aged from 3 to 6, 17% and 10% for those aged from 7 to 11, and 27% and 14% for those aged from 12 to18), the morbidity rate of lowered HDL-C was higher among 12-to-18-year olds (20%) than among 7-to-11-year olds (9%), and the morbidity rate of high TC among 3-to-6-year olds (9%) was higher than that among 7-to-11-year olds and 12-to-18-year-olds (4% and 3%) (P<0.05). Concerning region, the morbidity rates of low HDL-C were higher in the West (15%) than in the East (7%), and the morbidity rates of high TC and high LDL-C were higher in the East (7% and 6%) than in the West (3% and 2%) (P<0.05). Concerning BMI, the morbidity rates of dyslipidemia, high TG and high LDL-C were higher in obese children and adolescents (48%, 18%, 25%, and 7%) than in overweight (27%, 6%, 9%, and 4%) and normal children and adolescents (15%, 4%, 3%, and 3%) (P<0.05) .
The morbidity rate of dyslipidemia in Chinese children and adolescents is relatively high and varied across the age, region and BMI of children and adolescents. Due to the limitation of the number and quality of included studies, more high-quality studies are needed to be conducted to further validate these findings.
Ulcerative colitis (UC) is a persistent immune-mediated inflammatory bowel disease characterized by chronic relapses and remissions. The management of UC remains a subject of contention, particularly as approximately half of the patients experience a complex disease progression marked by chronic activity or frequent recurrence of common UC symptoms, significantly impacting their quality of life.
The current landscape presents a growing array of treatment modalities for UC. This study aims to systematically compare the relative efficacy and safety of biologics and small molecule drugs in treating patients with UC.
Two independent researchers meticulously conducted a search for randomized controlled trials involving biologics and small molecule drugs for UC. The search encompassed PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, and VIP. The intervention group involved either biologics or small molecule drugs, while the control group received a placebo. The quality of the included studies was assessed using the Cochrane Risk of Bias tool and RevMan 5.4. Paired analyses and network meta-analyses were conducted using R Studio. The surface under the cumulative ranking curve (SUCRA) was employed to rank the included drugs based on each outcome indicator, providing a comparative assessment of the clinical efficacy of diverse treatments for UC.
A total of 25 studies including 9 546 patients with ulcerative colitis and 10 intervention regimens (Filgotinib 100 mg, Filgotinib 200 mg, Upadacitinib, Tofacitinib, Etrolizumab, Adalimumab, Vedolizumab, Golimumab 50 mg, Golimumab 100 mg, Infliximab). The results of SUCRA probability ranking of clinical remission effect of each drug showed that Upadacitinib (94.1%) >Vedolizumab (85.1%) >Tofacitinib (74.3%) >Infliximab (72.7%) >Filgotinib 200 mg (51.5%) >Golimumab 100 mg (44.3%) >Golimumab 50 mg (39.3%) >Etrolizumab (38.9%) >Adalimumab (29.8%) >Filgotinib 100 mg (18.7%) >Placebo (0.7%). The results of SUCRA probability ranking of the effect of each drug on clinical response showed that Upadacitinib (98.4%) >Infliximab (84.4%) >Tofacitinib (67.2%) >Vedolizumab (58.4%) >Golimumab 50 mg (53.3%) >Adalimumab (34.6%) >Golimumab 100 mg (30.1%) >Placebo (0.4%). The results of SUCRA probability ranking of the effect of each drug on endoscopic remission showed that Upadacitinib (98.7%) >Tofacitinib (68.6%) >Filgotinib 200 mg (59.6%) >Adalimumab (55.2%) >Etrolizumab (46.0%) >Vedolizumab (45.9%) >Filgotinib 100 mg (23.4%) >Placebo (2.2%). The results of SUCRA probability ranking of the effect of each drug on mucosal healing showed that Upadacitinib (99.7%) >Tofacitinib (77.2%) >Infliximab (65.2%) >Golimumab 50 mg (46.4%) >Vedolizumab (44.4%) >Adalimumab (33.8%) >Golimumab 100 mg (31.9%) >Placebo (1.0%). The results of the SUCRA probability ranking of the risk of adverse events for each drug showed that Golimumab 100 mg (96.7%) >Golimumab 50 mg (92.1%) >Placebo (68.7%) >Tofacitinib (60.8%) >Adalimumab (60.7%) >Etrolizumab (47.2%) >Upadacitinib (42.2%) >Vedolizumab (41.3%) >Infliximab (27.0%) >Filgotinib 200 mg (6.6%) >Filgotinib 100 mg (6.2%) .
Upadacitinib demonstrated optimal efficacy in clinical response, clinical remission, mucosal healing, and endoscopic remission, and Filgotinib 100 mg demonstrating safer outcomes in terms of adverse events.
